Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding.

BACKGROUND/AIM: This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology. METHODS: Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method. Cox regression analyses were used to compare injury risk between the two groups, based on HRs and their 95% CIs, controlling for potential confounders. Stratified analyses were conducted to evaluate the effect of motion control system in runners with supinated, neutral and pronated feet. RESULTS: The overall injury risk was lower among the participants who had received motion control shoes (HR=0.55; 95% CI 0.36 to 0.85) compared to those receiving standard shoes. This positive effect was only observed in the stratum of runners with pronated feet (n=94; HR=0.34; 95% CI 0.13 to 0.84); there was no difference in runners with neutral (n=218; HR=0.78; 95% CI 0.44 to 1.37) or supinated feet (n=60; HR=0.59; 95% CI 0.20 to 1.73). Runners with pronated feet using standard shoes had a higher injury risk compared to those with neutral feet (HR=1.80; 95% CI 1.01 to 3.22). CONCLUSIONS: The overall injury risk was lower in participants who had received motion control shoes. Based on secondary analysis, those with pronated feet may benefit most from this shoe type.

A reliable measure of footwear upper comfort enabled by an innovative sock equipped with textile pressure sensors.

Footwear comfort is essential and pressure distribution on the foot was shown as a relevant objective measurement to assess it. However, asperities on the foot sides, especially the metatarsals and the instep, make its evaluation difficult with available equipment. Thus, a sock equipped with textile pressure sensors was designed. Results from the mechanical tests showed a high linearity of the sensor response under incremental loadings and allowed to determine the regression equation to convert voltage values into pressure measurements. The sensor response was also highly repeatable and the creep under constant loading was low. Pressure measurements on human feet associated with a perception questionnaire exhibited that significant relationships existed between pressure and comfort perceived on the first, the third and the fifth metatarsals and top of the instep. Practitioner Summary: A sock equipped with textile sensors was validated for measuring the pressure on the foot top, medial and lateral sides to evaluate footwear comfort. This device may be relevant to help individuals with low sensitivity, such as children, elderly or neuropathic, to choose the shoes that fit the best.

Shoe drop has opposite influence on running pattern when running overground or on a treadmill.

PURPOSE: Minimalist running shoes are designed to induce a foot strike made more with the forepart of the foot. The main changes made on minimalist shoe consist in decreasing the height difference between fore and rear parts of the sole (drop). Barefoot and shod running have been widely compared on overground or treadmill these last years, but the key characteristic effects of minimalist shoes have been yet little studied. The purpose of this study is to find whether the shoe drop has the same effect regardless of the task: overground or treadmill running. METHODS: Twelve healthy male subjects ran with three shoes of different drops (0, 4, 8 mm) and barefoot on a treadmill and overground. Vertical ground reaction force (vGRF) (transient peak and loading rate) and lower limb kinematics (foot, ankle and knee joint flexion angles) were observed. RESULTS: Opposite footwear effects on loading rate between the tasks were observed. Barefoot running induced higher loading rates during overground running than the highest drop condition, while it was the opposite during treadmill running. Ankle plantar flexion and knee flexion angles at touchdown were higher during treadmill than overground running for all conditions, except for barefoot which did not show any difference between the tasks. CONCLUSIONS: Shoe drop appears to be a key parameter influencing running pattern, but its effects on vGRF differ depending on the task (treadmill vs. overground running) and must be considered with caution. Unlike shod conditions, kinematics of barefoot condition was not altered by treadmill running explaining opposite conclusions between the tasks.

Aging of running shoes and its effect on mechanical and biomechanical variables: implications for runners.

This study investigates the effect of running shoes' aging on mechanical and biomechanical parameters as a function of midsole materials (viscous, intermediate, elastic) and ground inclination. To this aim, heel area of the shoe (under calcaneal tuberosity) was first mechanically aged at realistic frequency and impact magnitudes based on a 660 km training plan. Stiffness (ST) and viscosity were then measured on both aged and matching new shoes, and repercussions on biomechanical variables (joint kinematics, muscular pre-activation, vertical ground reaction force and tibial acceleration) were assessed during a leg-extended stepping-down task designed to mimic the characteristics of running impacts. Shoes' aging led to increased ST (means: from 127 to 154 N ∙ mm(-1)) and decreased energy dissipation (viscosity) (means: from 2.19 to 1.88 J). The effects induced by mechanical changes on body kinematics were very small. However, they led with the elastic shoe to increased vastus lateralis pre-activation, tibial acceleration peak (means: from 4.5 g to 5.2 g) and rate. Among the three shoes tested, the shoe with intermediate midsole foam provided the best compromise between viscosity and elasticity. The optimum balance remains to be found for the design of shoes regarding at once cushioning, durability and injury prevention.

Determination of optimal shoe fitting for children tennis players: Effects of inner-shoe volume and upper stiffness.

The purpose of this study was to determine the optimal inner-shoe volume for children tennis players. Sixteen participants, aged from 8 to 12 years old assessed comfort of 6 shoes, which were a combination of 3 lasts (thin, medium and wide) and 2 upper constructions (flexible and stiff), while a sock equipped with textile sensors was measuring the pressure applied on their foot. The thin last was based on the proportion of an adult last. The widest shoes produced the lowest pressure on the 1st and 5th metatarsal heads, the medial midfoot and the medial and lateral heel (p < 0.05), whilst they were perceived the most comfortable for the 3rd and 5th metatarsal heads, the 5th metatarsal base and the medial and lateral heel (p < 0.05). These outcomes indicated that footwear manufacturers should design wider shoes for children than for adults.

Perceiving slipperiness and grip: A meaningful relationship of the shoe-ground interface.

The present study investigated the relationship between objective measurements of the available (CoFA), the utilized (CoFU) coefficient of friction and subjective perception of grip or slipperiness. It was hypothesized that significant correlations exist between the perception of grip or slip and the CoF during sports movement and that a minimum CoF was needed to ensure an optimal grip/slipperiness perception. Eighteen healthy active females performed forward and backward cutting tasks onto a forceplate. Six shoes and two floors were used to induce different grip conditions. Subjective ratings and CoFU were assessed for each shoe-floor combination, and mechanical CoFA was also measured in a specific test bed. Significant relationships (p<0.001) were found between grip, slipperiness ratings or CoFA with the CoFU (r=0.98, r=-0.97, r=0.88, respectively). Individual sensory thresholds of the minimum required CoFU were also determined using probit models between the CoFU and the grip acceptability. The mean threshold defined in the present study was 0.70±0.11. This meant that below this threshold, the grip perception was not acceptable, whereas above this threshold, the grip was felt good enough to perform the task. In conclusion, strong relationships between subjective perceptions and objective measurements of friction were found in sports-like movements. Moreover, a minimum friction requirement was defined for indoor dry shoe-floor conditions. The present study gives new insights of the shoe-floor interaction and outlines friction requirements for the manufacturers of sports floor or footwear.

Shoe drop reduction influences the lower limb biomechanics of children tennis players during an open stance forehand: A longitudinal study.

Compared to traditional tennis shoes, using 0-drop shoes was shown to induce an immediate switch from rear- to forefoot strike pattern to perform an open stance tennis forehand for 30% of children tennis players. The purpose of the study was to examine the long-term effects of a gradual reduction in the shoe drop on the biomechanics of children tennis players performing open stance forehands. Thirty children tennis players participated in 2 laboratory biomechanical test sessions (intermediate: +4 months and final: +8 months) after an inclusion visit where they were randomly assigned to control (CON) or experimental (EXP) group. CON received 12-mm-drop shoes twice, whereas EXP received 8 mm then 4-mm-drop shoes. Strike index indicated that all CON were rearfoot strikers in intermediate and final test sessions. All EXP were rearfoot strikers in intermediate test session, but half the group switched towards a forefoot strike pattern in final test session. This switch resulted in a decreased loading rate of the ground reaction force (-73%, p = .005) but increased peak ankle plantarflexors moment (+47%, p = .050) and peak ankle power absorption (+107%, p = .005) for these participants compared with CON. Biomechanical changes associated with the long-term use of partial minimalist shoes suggest a reduction in heel compressive forces but an increase in Achilles tendon tensile forces.

The influence of shoe aging on children running biomechanics.

Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (-11%, p=0.010 and -12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.

Influence of exercise type on metabolic cost and gross efficiency: elliptical trainer versus cycling trainer.

BACKGROUND: Elliptical trainers are known as a good mean to develop physical fitness. However, the pedaling efficiency on an elliptical trainer has not been reported in the literature. The aim of the present study was to compare metabolic cost and gross efficiency for two different trainers - the elliptical trainer (ET) and the cycling trainer (CT). METHODS: Fourteen participants were tested on ET and CT during two exercise sessions. Participants pedaled at 9 different power outputs for 3 minutes each. Oxygen consumption (VO2) and heart rate (HR) were recorded. Gross efficiency (GE) was calculated during the last 30s of each 3min period. Maximal aerobic power (MAP) was estimated for each participant for each condition. RESULTS: MAP was found to be significantly greater in CT (237±88W) compared to ET (151±51 W). Significant positive correlations were found between power output and VO2 in both CT (r=0.93) and ET conditions (r=0.97). Regarding the inter-individual variability in MAP, GE was significantly correlated to the relative power output (%MAP) (r=0.75 in CT and r=0.69 in ET). CONCLUSIONS: The aim of the present study was to investigate metabolic demand of different exercise type using %MAP in each condition. The results confirmed that metabolic cost of ET was greater than CT at similar %MAP. Gross efficiency was lowered in ET condition compared to CT. This could be explained through the additional use of arms and the standing position during ET.

The influence of shoe drop on the kinematics and kinetics of children tennis players.

This study investigated the immediate effects of reducing the shoe drop (i.e. the difference between the heel and the forefoot height) on the kinematics and kinetics of the lower extremities of children tennis players performing a tennis-specific movement. Thirteen children tennis players performed a series of simulated open stance forehands wearing 3 pairs of shoes differing only in the drop: 0 (D0), 6 (D6) and the control condition of 12 mm (D12). Two embedded forceplates and a motion capture system were used to analyse the ground reaction forces and ankle and knee joint angles and moments of the leading lower limb. In D6 compared with D12, the peak impact force was reduced by 24% (p = .004) and the ankle was less dorsiflexed at foot strike (p = .037). In D0 compared with D12, the peak impact force was reduced by 17% (p = .049), the ankle was less dorsiflexed at foot strike (p = .045) and the knee was more flexed at foot strike (p = .007). In addition, 4 out of 13 participants (31%) presented a forefoot strike pattern for some of the trials in D0. No difference was observed across shoe conditions for the peak knee extensor moment (p = .658) or the peak ankle plantarflexor moment (p = .071). The results provide preliminary data supporting the hypothesis that for children tennis players, using a 6-mm lower shoe drop might reduce heel impact forces and thus limit potentially impact-related injuries.

Inter-segmental coordination: motor pattern in humans stepping over an obstacle with mechanical ankle joint friction.

This study examined the influence of a mechanical perturbation of the ankle joint on obstacle avoidance pattern. A decoupled control between the distal joint and the combined (hip-knee) proximal joints was observed according to the task requirement. In this context, a greater mechanical friction at the ankle should be compensated at this joint (local compensation) or alternatively, by regulating more combined proximal joints (knee and/or hip). The leading limb inter-segmental coordination was evaluated in both no constraint and constraint conditions in calculating ranges of motion (ROM), moments of force and powers (from heel-off to obstacle) at the ankle, knee and hip joints. Electromyographic activities were also analyzed. With the constraint, the dorsiflexor moment and the tibialis anterior activity remained unchanged while both ROM and power bursts (absorbed and generated) decreased. The hip and knee ROM remain invariant. At heel-off the absorption by hip extensors decreased and the forthcoming generation by knee flexors increased in the constraint condition. To quantify the inter-joint coordination, principal component analysis was used and indicated a high level of inter-joint coupling (synergy) that decreased with the constraint (i.e. less inter-joint coupling). At the ankle joint, the results suggest that the central command was the same in both conditions thus, not be adapted. At both the hip and knee joints, a combined joints modulation occurred to overcome additional friction.

Does wearing shoes affect your biomechanical efficiency?

Studies involving minimalist shoes have dramatically increased this past 10 years. While a deeper knowledge of the related modifications has ensued regarding the kinematics, electromyographic, and dynamic patterns, little is known regarding the modifications at the muscle forces and muscle fiber levels. The aim of the present study was to assess at a muscular level the modifications brought up when running barefoot, using 0mm midsole height running shoe, or using classical midsole height running shoes. An EMG-Driven model that combines the kinematics, dynamics, and electromyographic data was used to estimate the Triceps Surae (TS) muscle forces and fiber behavior during running using different footwear conditions. Despite differences at the joint level between barefoot and shod running when looking at ankle joint range of motion, or foot-ground angle at touchdown, the results showed no effect of footwear neither on the maximal muscle forces nor on the relative amount of force produced by each muscle within the TS muscle group when wearing different footwear. On the contrary, different behaviors of muscle fibers were shown with lower amplitudes of fiber lengths for the Gastrocnemii biarticular muscles when running barefoot. This particular results reveal that wearing a shoe, even with a very thin sole, could deeply modify the intricate muscle-tendon mechanics of running.

Is midsole thickness a key parameter for the running pattern?

Many studies have highlighted differences in foot strike pattern comparing habitually shod runners who ran barefoot and with running shoes. Barefoot running results in a flatter foot landing and in a decreased vertical ground reaction force compared to shod running. The aim of this study was to investigate one possible parameter influencing running pattern: the midsole thickness. Fifteen participants ran overground at 3.3 ms(-1) barefoot and with five shoes of different midsole thickness (0 mm, 2 mm, 4 mm, 8 mm, 16 mm) with no difference of height between rearfoot and forefoot. Impact magnitude was evaluated using transient peak of vertical ground reaction force, loading rate, tibial acceleration peak and rate. Hip, knee and ankle flexion angles were computed at touch-down and during stance phase (range of motion and maximum values). External net joint moments and stiffness for hip, knee and ankle joints were also observed as well as global leg stiffness. No significant effect of midsole thickness was observed on ground reaction force and tibial acceleration. However, the contact time increased with midsole thickness. Barefoot running compared to shod running induced ankle in plantar flexion at touch-down, higher ankle dorsiflexion and lower knee flexion during stance phase. These adjustments are suspected to explain the absence of difference on ground reaction force and tibial acceleration. This study showed that the presence of very thin footwear upper and sole was sufficient to significantly influence the running pattern.

The influence of footwear on foot motion during walking and running.

There are evidences to suggest that wearing footwear constrains the natural barefoot motion during locomotion. Unlike prior studies that deduced foot motions from shoe sole displacement parameters, the aim of this study was to examine the effect of footwear motion on forefoot to rearfoot relative motion during walking and running. The use of a multi-segment foot model allowed accurate both shoe sole and foot motions (barefoot and shod) to be quantified. Two pairs of identical sandals with different midsole hardness were used. Ten healthy male subjects walked and ran in each of the shod condition. The results showed that for barefoot locomotion there was more eversion of the forefoot and it occurred faster than for shod locomotion. In this later condition, the range of eversion was reduced by 20% and the rate of eversion in late stance by 60% in comparison to the barefoot condition. The sole constrained both the torsional (eversion/inversion) and adduction range of motion of the foot. Interestingly, during the push-off phase of barefoot locomotion the rate and direction of forefoot torsion varied between individuals. However, most subjects displayed a forefoot inversion direction of motion while shod. Therefore, this experiment showed that the shoes not only restricted the natural motion of the barefoot but also appeared to impose a specific foot motion pattern on individuals during the push-off phase. These findings have implications for the matching of footwear design characteristics to individual natural foot function.